Palliative care services
Carelon Palliative Care helps health plans manage high-cost members with serious illness through physician-led palliative and supportive care. By coordinating care early, we reduce avoidable utilization, improve outcomes, and deliver measurable ROI.
The value of more support for your members with complex needs
Carelon Palliative Care is designed specifically for members with serious illnesses and complex healthcare needs. By providing earlier support and helping stabilize these members, health plans can reduce avoidable healthcare spending while improving care quality and the member experience.
With Carelon, health plans can:
- Reduce avoidable ED visits, hospitalizations, and ICU utilization1
- Improve member experience and quality performance2
- Deliver 3:1 ROI with more predictable total cost of care3
Request a consultation to see your potential impact.
See how leading health plans reduce cost with palliative care
Download our eBook to learn how a proactive palliative care program can stabilize high-risk members, reduce emergency and inpatient utilization, and improve financial performance at scale while delivering a better experience for members and caregivers.
What is palliative care?
Palliative care — also known as supportive care — is specialized medical care for people living with serious illness that improves quality of life while reducing unnecessary healthcare utilization.
Unlike hospice care, palliative care can be provided at any stage of illness and alongside curative treatment.
A comprehensive palliative care program includes:
Symptom and medication management
Coordination across providers and care settings
Emotional, behavioral, and social support
Advance care planning aligned to member goals
Why serious illness drives disproportionate healthcare cost
Percentage of healthcare spenders
A small percentage of members, and often those living with serious illness, drive a disproportionate share of healthcare spend.4
Members with serious illness often receive care that is fragmented across multiple providers, reactive rather than proactive, and concentrated in high-cost settings such as hospitals and intensive care units.
This creates both financial and member experience challenges, driving avoidable emergency department visits and hospital admissions, increasing variability in claims and healthcare spending, and resulting in poorer experiences during some of the most critical moments of care.
Health plans are often paying the most for the least coordinated and most avoidable care. This is not just a utilization issue. It’s a care model issue.
Want the full breakdown of cost drivers and savings opportunities?
Download the palliative care eBook to see how health plans are reducing avoidable utilization and improving financial performance.
A model for high-cost members
Traditional care models are episodic and reactive. Serious illness requires a different approach — one that is proactive, continuous, and coordinated.
Carelon Palliative Care delivers physician-led palliative care services designed to stabilize high-risk members before conditions escalate.
Care is delivered where members are most comfortable: at home, virtually, or by phone. These home-based palliative care services can help prevent unnecessary utilization as they shift care from reactive, hospital-based utilization to proactive, home-centered management.
How Carelon delivers palliative care services
Carelon delivers a serious illness care program through a proactive, longitudinal model designed to prevent escalation and not just respond to it. Acting as a clinical guide, Carelon helps members, families, and providers make informed decisions throughout the care journey.
Access to a range of services
Different medications call for different kinds of guidance and care. Specialty medications, maintenance prescriptions, and infusion therapies may each require a distinct approach to delivery, education, coordination, or clinical support.
Guide care across the journey
A physician-led interdisciplinary team delivers ongoing support, coordinating across primary care, specialists, and caregivers to ensure aligned, goal-directed care.
Reroute before crises happen
With 24/7 clinical access, Carelon intervenes in real time to manage symptoms and help prevent avoidable ED visits, hospitalizations, and escalation.
How supporting the member experience can help reduce cost
What members experience:
- 24/7 access to a trusted clinical team
- Symptoms managed early, before escalation
- Clear care plans aligned to personal goals
- Support navigating complex care decisions
- Care delivered comfortably at home
What health plans see:
- Fewer ED visits and avoidable admissions
- Lower inpatient and ICU utilization
- Reduced duplication and unnecessary services
- Earlier, appropriate transitions to hospice
- More predictable utilization patterns
Proven financial and clinical outcomes for health plans
Carelon Palliative Care delivers measurable financial and clinical impact for health plans. In addition to reducing total cost of care, Carelon makes spend more predictable by stabilizing high-risk members before crises occur.
Cost and utilization
- Up to 3:1 return on investment3
- Significant reductions in hospital admissions
- Lower total cost of care across Commercial, Medicare, and Medicaid
Quality and experience
- 79 Net Promoter Score (NPS) — rated “excellent”5
- High member and caregiver satisfaction
Care alignment
- 93% advance care planning discussions (vs. ~50% benchmark)6
More goal-aligned care and reduced unwanted high-intensity interventions
Which members benefit from palliative care
Carelon supports members living with serious illness and complex chronic conditions who are at high risk of avoidable utilization, including:
- Advanced cancer
- Heart failure
- COPD
- End-stage renal disease
- Neurologic conditions and dementia
- Other complex, high-risk conditions
Members are identified through advanced analytics, provider referrals, and care management collaboration.
Why health plans choose Carelon for palliative care
Health plans partner with Carelon because of our ability to deliver both financial and clinical results at scale. Most palliative care programs focus on services. Carelon delivers a physician-led model designed to change outcomes at scale.
The Carelon difference
Physician-led care
Proven ability to engage complex, high-risk member
Deep expertise in serious illness care
National scale across all lines of business
Measurable ROI and predictable cost reduction
Frequently asked questions
See your potential impact
Ready to improve outcomes and reduce cost for your highest-risk members? Request a consultation to see your projected savings and eligible member population.
1 Carelon: Program Evaluation for Select Health Plans (2023).
2 Centers for Medicare & Medicaid Services: Palliative Care Projects: Synthesis of Evaluation Results 2012–2021 (accessed September 11, 2026): cms.gov/priorities/innovation/data-and-reports/2022/palliative-care-synthesis-2012-2021 .
3 Carelon internal data, 2025. Measurement period: January–December 2023.
4 Center to Advance Palliative Care: Palliative Care: Facts and Stats (accessed October 2024): https://www.capc.org/documents/download/665/ .
5 Carelon Health Palliative Care Patient Experience Survey, May 2025–April 2026.
6 Carelon Health JOC D